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Enhancement: Financial Set Approval (Doc ID 2314567.1)

Last updated on APRIL 10, 2018

Applies to:

Oracle Health Insurance Claims Adjudication - Version 2.17.2.0.0 and later
Information in this document applies to any platform.

Goal

Enhancement Request:
The request is for a comprehensive functionality for creating/managing/approving financial sets for financial messages. In other words, a way to independently approve sets for creation of financial messages.
Use case: Currently there is no way for a business person to confirm that the financial transactions for a set can be created. It should be possible when creating a set to indicate that it requires approval(blocking creation of financial messages) and then for someone with the right access permission to lock such a set (preventing more transactions from entering), review the contents (using external reports), and release it for payment. Ideally, it would be possible to provide a list of 'set-level financial holds' that should be added when creating the set. In this case this feature would be used to add holds for the various finance teams that need to approve payments.


Workaround: Currently several holds must be added to each claim, but the management/release of these holds is performance costly and it does not cover all requirements.

Solution

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